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4                                                                                                                                                      4
5                                                             WEST VIRGINIA                                                                            5
6                                                                                                                                                      6
      REVCIT-1208/23    W                CORPORATION NET INCOME TAX RETURN                                                 2023
7     TAX PERIOD BEGINNING                                                ENDING                                EXTENDED                               7
8                      MM/DD/YYYY                                        MM/DD/YYYY                             DUE DATE                               8
                                                                                                                MM/DD/YYYY
9                                                                                                                                                      9
10 CORPORATION NAME                                                                   FEIN                                                             10
11                                                                                                                                                     11
12                                                                                                                                                     12
13 MAILING ADDRESS                                                                    WV CORPORATION INCOME TAX ACCOUNT NUMBER                         13
14                                                                                                                                                     14
15                                                                                                                                                     15
16 CITY                                        STATE ZIP                                                                                               16
17                                                                                     CHANGE OF ADDRESS                                               17
18                                                                                                                                                     18
19 STATE OF DOMICILE              NAICS                     CONTACT NAME                                       CONTACT PHONE                           19
20                                                                                                                                                     20
21                                                                                                                                                     21
22                                                                                                                                                     22
                                                                         1) ENTITY 
23 CHECK ALL APPLICABLE BOXES                                             TYPE        CORPORATION          NONPROFIT                                   23
24                                                                                                                                                     24
25 2) RETURN TYPE      ANNUAL                         INITIAL             FINAL       AMENDED              RAR (Form 870 or 4549-A/B must be provided) 25
26                                                                                                                                                     26
27                     52/53 WEEK FILER  DAY OF WEEK ENDING                                                FISCAL          OTHER                       27
28                                                                                                                                                     28
29 3) IF FINAL/SHORT/  CEASED OPERATIONS IN WV        CHANGE OF OWNERSHIP             CHANGE OF FILING STATUS     MERGER                               29
      INITIAL RETURN
30                                                                                                                                                     30
31                     SUCCESSOR  FEIN OF PREDECESSOR                                 TECHNICAL TERMINATIONS      OTHER                                31
32                                                                                                                                                     32
33                                                                                                                                                     33
34 4) FILING METHOD    SEPARATE ENTITY                CHECK HERE IF SEPARATE BUT PART OF FEDERAL CONSOLIDATED. ENTER FEIN:                             34
35                                                                                                                                                     35
36                     COMBINED                       SEPARATE COMBINED                                                                                36
37                     (UB-CR)                                                                                                                         37
38                                                    GROUP COMBINED  SURETY FEIN:                                                                     38
39                                                                                                                                                     39
40                                                    WORLDWIDE ELECTION                                                                               40
41                                                                                                                                                     41
42 5) IF SEPARATE, INDICATE ACTIVITY                  WHOLLY WV ACTIVITY (SCHEDULE 1) MULTISTATE ACTIVITY (SCHEDULE 2)                                 42
                                                      (WV ACTIVITY ONLY) 
43                                                                                                                                                     43
44 6) REPORTABLE ENTITIES (ALL ENTITIES MUST BE INCLUDED ON SCHEDULE D)                                                                                44
45                     A. ANY PTE YOU ARE A PARTNER, MEMBER, OR SHAREHOLDER DOING BUSINESS IN WV                                                       45
46                                                                                                                                                     46
47                     B. ANY ENTITY YOU OWN 80% OF VOTING STOCK                      D. ANY DISREGARDED ENTITY                                        47
48                                                                                                                                                     48
49                     C. ANY ENTITY THAT OWNED MORE THAN 80% OF YOUR STOCK           E. ANY CONTROLLED FOREIGN CORPORATION                            49
50                                                                                                                                                     50
51 7) CURRENTLY UNDER AUDIT BY THE IRS?  NO           YES                                                                                              51
52                                                    YEARS UNDER AUDIT:                                                                               52
53                                                                                                                                                     53
54 8) TYPE OF FEDERAL RETURN INCLUDED WITH THIS RETURN                    1120        PROFORMA 1120        990             990T                        54
55                                                                                                                                                     55
56                                                                                                                                                     56
57                                                                                                                                                     57
58                                                                                                                                                     58
59                                                                                                                                                     59
60                                                                                                                                                     60
61                                                                                                                                                     61
62                                                                                                                                                     62
                                                                                           *B30202301W*
63                                                                                         B30202301W                                                  63
   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980

   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
4                                                                                                                                                                                              4
5        NAME                                                                                                            FEIN                                                                  5
6                                                                                                                                                                                              6
7  9. Adjusted Corporate Net Income Tax from Schedule 1,Schedule 2, or UB-CR .....                                    9                .00                                                     7
8                                                                                                                                                                                              8
9  10. Prior year carryforward credit...................................................................      10                   .00                                                         9
10                                                                                                                                                                                             10
11 11. Estimated and extension payments.........................................................              11                   .00                                                         11
12 12. Withholding must match the withholding statements unless withholding                                                                                                                    12
13     is from NRSR.......................................................................................... 12                   .00                                                         13
14       CHECK HERE IF WITHHOLDING IS FROM NRSR (NONRESIDENT SALE OF REAL ESTATE)                                                                                                              14
15                                                                                                                                                                                             15
16 13. Build WV Property Value Adjustment Tax Credit .....................................                    13                   .00                                                         16
17                                                                                                                                                                                             17
18 14. Payments (add lines 10 through 13) ........................................................................... 14                           .00                                         18
19                                                                                                                                                                                             19
20 15. Overpayment previously refunded or credited (amended return only)........................                      15                           .00                                         20
21                                                                                                                                                                                             21
22 16. TOTAL PAYMENTS (subtract line 15 from line 14) ....................................................            16                           .00                                         22
23                                                                                                                                                                                             23
24 17. If line 16 is larger than line 9, enter overpayment ......................................................     17                           .00                                         24
25                                                                                                                                                                                             25
26 18. Amount of line 17 to be credited to next year’s tax....................................................        18                           .00                                         26
27                                                                                                                                                                                             27
28 19. Amount of line 17 to be refunded (subtract line 18 from line 17)...............................                19                           .00                                         28
29                                                                                                                                                                                             29
30 20. If line 16 is smaller than line 9, enter tax due here....................................................      20                           .00                                         30
31                                                                                                                                                                                             31
32 21. Interest for late payment (see instructions).................................................................  21                           .00                                         32
33                                                                                                                                                                                             33
34 22. Additions to tax for late filing and/or late payment (see instructions)..........................              22                           .00                                         34
35                                                                                                                                                                                             35
36 23. Penalty for underpayment of estimated tax ................................................................     23                           .00                                         36
37                                                                                                                                                                                             37
38 24. TOTAL DUE with this return (add lines 20 through 23).............................................              24                           .00                                         38
39                                                                                                                                                                                             39
40                                                                                                                                                                                             40
  Direct Deposit              CHECKING          SAVINGS
41 of Refund                                                                                                                                                                                   41
42                                                                                                            ROUTING NUMBER  ACCOUNT NUMBER                                                   42
                                          INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
43                                              PLEASE SEE PAGE 3 OF INSTRUCTIONS FOR PAYMENT OPTIONS.                                                                                         43
44 I authorize the Tax Division to discuss my return with my preparer    YES    NO                                                                                                             44
45 Under penalty of perjury, I declare that I have examined this return, accompanying schedules, and statements, and to the best of my knowledge and belief, it is true, correct and complete. 45
46                                                                                                                                                                                             46
47                                                                                                                                                                                             47
48 Signature of Officer/Partner or Member                               Print name of Officer/Partner or Member               Date                                                             48
49                                                                                                                                                                                             49
50                                                                                                                                                                                             50
51 Title                                                                                       Email                          Business Telephone #                                             51
52                                                                                                                                                                                             52
53                                                                                                                                                                                             53
54 Signature of paid preparer                                           Print name of Preparer                                Date                                                             54
55                                                                                                                                                                                             55
56                                                                                                                                                                                             56
57                                                                                                                                                                                             57
58 Firm’s name and address                                                                     Preparer’s Email               Preparer’s Telephone #                                           58
59                                                                                                                                                                                             59
60 MAIL TO:  WEST VIRGINIA TAX DIVISION                                                                                                                                                        60
         TAX ACCOUNT ADMINISTRATION 
61       PO BOX 1202                                                                                                                                                                           61
62       CHARLESTON WV 25324-1202                                                                                                                                                              62
                                                                                                                         *B30202302W*
63                                                                                                                           B30202302W                                                        63
   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980